HomeMy WebLinkAboutPIP 98-07B; VIASAT DISH FARM; Planned Industrial Permit (PIP)• CITY OF CARLSBAD • LAND USE REVIEW APPLICATION /-Jl-o
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APPLICATIONS APPLIED FOR: (CHECK BOXES)
Administrative Permit
Administrative Variance
Coastal Development Permit
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Condominium Permit
Environmental Impact Assessment
General Plan Amendment
(FOR DEPT. USE ONLY)
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Planned Development Permit
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Pl/\ed lndustri~
Plann~nifs'sion \
Determination
Precise Development Plan
Redevelopment Permit
Site Development Plan
Special Use Permit
Specific Plan
(FOR DEPT. USE ONLY)
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Habitat Management Plan Permit
Hillside Development Permit ---□ Tentative Parael Map
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Local Coastal Program Amendment
Master Plan
Minor Conditional Use Permit fv{.
Non-Residential Planned Development
ASSESSOR PARCEL NO(S).:
Obtain from Engineering Department
Tentative Tract Map
Variance
Zone Change
List other applications not
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PROJECT NAME:\;/flSA, :t]~~~~!::='.::::::!:I::!~:±~~~~:..:..J~EJ1.L_--1~
5) OWNER NAME (Print or Type)
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MAILING ADDRESS Jk
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CITY AND STATE ZIP TELEPHONE
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I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
UE AND CORRECT TO OF MY
6) APPLICANT NAME (Print or Type)
VlASi\T; I ~G ,
MAILING ADDRESS
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CITY AND STATE ZIP TElf"7~<0~E
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EMAIL ADDRESS:
SIGNATU
T I AM THE LEGAL REPRESENTATIVE OF THE
TALL THE ABOVE INFORMATION IS TRUE AND
ST OF MY KNOWLEDGE. \-f//'D £,
DAE
NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPLICATIONS BE FILED, MUST BE SUBMITTED PRIOR TO 3:30 P.M.
A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION BE FILED, MUST BE SUBMITTED PRIOR TO 4:00 P.M. -?._ \J
Form 14 Rev. 03/08 r::osos O fiAGd 1 OF 4
7) BRIEF LEGAL DESCRIPTION
8) LOCATION OF PROJECT:
STREET ADDRESS
ONTHE! ~\ I SIDEOF/8-.Q\0\~ ~
(NORTH, SOUTH, EAST, WEST) (NAME OF STREET)
BETWEEN R-v)U)~ ,\\ff~Wj:e'
(NAME OF STREET)
AND jQ£>~ ()s-Lft :f'i\J6
(NAME OF STREET)
9) IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY
STAFF, PLANNING COMMISSIONERS, DESIGN REVIEW BOARD MEMBERS OR CITY COUNCIL MEMBERS TO
INSPECT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS APPLICATION. I/WE CONSENT TO
ENTRY FOR THIS PURPOSE.
10) NOTICE OF RESTRICTION: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF
RESTRICTION BEING RECORDED ON THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE
Av-l"'"tl:t'wl"\NT. E OF RESTRICTIONS RUN WITH THE LAND AND BIND ANY SUCCESSORS IN INTEREST.
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FOR CITY USE ONLY
Form 14 Rev. 03/08
RECEIVED
OEC 21. 2008
OJ 6.MN\NG DEPT RECEIVEB'BY!
PAGE 2 OF 4
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Project Description 10/96 Page 1 of 1
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City' of Carlsbad
IREili,i•li·l·J4•E•iilii4Ui
DISCLOSURE STATEMENT
Applicant's statement or disclosure of certain ow·nership interests on all applications which will require
discretionary action on the part of the City Council or any appointed Board, Commission or Committee.
The fallowing information M.Yfil be disclosed at the time of application submittal. Your project cannot be
reviewed until this information is completed. Please print.
1. APPLICANT (Not the applicant's agent)
Provide the COMPLETE. LEGAL names and addresses of lli persons having a financial interest
in the application. If the applicant includes a corporation or partnership. include the names, tltle,
addresses of all individuals owning more than 10% of the shares. IF NO INDIVIDUALS OWN MORE
THAN 10% OF THE SHARES, PLEASE INDICATE NON-APPLICABLE (N/A) IN THE SPACE
BELOW. If a publicly-owned corporation, inciude the names, titles, and addresses of the corporate
officers. (A separate page may be attached if necessary.)
Person________ Corp/Part Vt-A~fil , \~C,., J
Title __________ _ Title ____________ _
Address _________ _
2. OWNER (Not the owner's agent}
Provide the COMPLETE. LEGAL names and addresses of ALL persons having any ownership,
interest in the property involved. Also, provide the nature of the legal ownership (i.e, partnership,
tenants in common, non-profit, corporation, etc.). If the ownership includes a corporation or
partnershi12, include the names, title, addresses of all individuals owning more than 10% of the
shares. IF NO INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE INDICATE
NON-APPLICABLE (NIA) IN THE SPACE BELOW. If a publicly-owned corporation, include the
names, titles, and addresses of the corporate officers. (A separate page may be attached if
necessary.)
Person. _________ _
Title __________ _
Address. _________ _
Corp/Part L.t3v\~~ \(\)\ffil'fl\')~ L\~~
Title. ____________ _
Address \loZ... 5. -\t\GMLttJO ~~ 6 iD
F~\-10~')( ,ft-z-, ~SD~6
I
1635 Faraday Avenue• Carlsbad, CA 92008-7314 • (760) 602·4600 • FAX (760) 602-8559 • www.ci.carlsbad.ca.us @
3. NON-PROFIT ORGANIZATION OR TRUST
If any person identified pursuant to (1) or (2) above is a nonprofit organization or a trust, list the
names and addresses of ~ person serving as an officer or director of the non-profit
organization or as trustee or beneficiary of the.
Non Profit/Trust________ Non Profit/Trust ________ _
Title___________ Title ____________ _
Address _________ _ Address ·------------
4. Have you had more than $500 worth of business transacted with any member of City staff,
Boards, Co~ons, Committees and/or Council within the past twelve (12) months?
0 Yes ;2Q No If yes, please indicate person(s): __________ _
NOTE: Attach additional sheets if necessary.
I certify that all the above information is true and correct to the best of my knowledge.
Signature of applicant/date
Print or type name of applicant
~ Gtt6fO . ~ ~--01
Print or type name of owner/applicant's agent
H:ADMIN\COUNTER\DISCLOSURE STATEMENT 12/06 Page 2 of 2
HAZARDOUS WASTE AND SUBSTANCES STATEMENT
Consultation Of Lists of Sites Related To Hazardous Wastes
(Certification of Compliance with Government Code Section 65962.S)
Pursuant to State of California Government Code Section 65962.5, I have consulted the Hazardous
Wastes and Substances Sites List compiled by the California Environmental Protection Agency and
hereby certify that (check one):
~ The development project and any alternatives proposed in this application are not contained on ~ the lists compiled pursuant to Section 65962.5 of the State Government Code.
D The development project and any alternatives proposed in this application m contained on the
lists compiled pursuant to Section 65962.5 of the State Government Code.
APPLICANT
Name:\)~ 1\&G,
l
Address:'W\~, tSL-(~!~ M:-\_J
~-~~ [A, cr~o
I
Phone Number: L--ioo) df 7 6 -2.,, 7,,0 0
PRO~ERTY OWNER
Name:L_..ENI~ H~'i~µ LJct')ll1=£) R~~
Address: \70-Z-B -"tt\~.0-;?k\J8' *2.\rO
~\K, A~,, -~s-o \{p
Phone Number:. ___________ _
AddressofSite: 01bl ~ G:\W)\1'SO i2-efr<-,~CbAD.Gl-/Sj'L.Gor& . J I
Local Agency (City and ~ounty): ~6-W , ~ 0 l ~ ~ ~J:j J
Assessor's book, page, and parcel number: Z.,\'6 -l<o<O -oz. . \~ 1v'f-v\( 0
Specify list(s):. ___________________________ _
Regulatory Identification Number:. _____________________ _
Date of Lit: ___________________________ _
t\dmin/Countcr/HazWaslc
(
I SECTION 1
NEW DEVELOPMENT
PRIORITY PROJECT TYPE YES NO Does you project meet one or more of the following criteria:
1. Home subdivision of 100 units or more. V Includes SFD, MFD, Condominium and Apartments
2. Residential development of 10 units or more. X Includes SFD, MFD, Condominium and Apartments
3. Commercial and industrial development greater than 100,000 square feet including_ parking_ areas . . k Any development on private la_nd that is not for heavy industrial or residential uses. Example: Hospitals,
Hotels, Recreational Facilities, Shopping Malls, etc.
4. Heavy Industrial I Industry greater than 1 acre (NEED SIC CODES FOR PERMIT BUSINESS TYPES) IV SIC codes 5013, 5014, 5541, 7532-7534, and 7536-7539
5. Automotive repair shop. G( SIC codes 5013, 5014, 5541, 7532-7534, and 7536-7539
6. A New Restaurant where the land area of development is 5,000 square feet or more including parking X areas.
SIC code 5812
7. Hillside development K (1) greater than 5,000 square feet of impervious surface area and (2) development will grade on any
natural slope that is 25% or Qreater
8. Environmentally Sensitive Area (ESA). IX Impervious surface of 2,500 square feet or more located within, "directly adjacent"2 to (within 200 feet),
or "discharoino directly to"3 receivinq water within the ESA 1
9. Parking_ lot. X Area of 5,000 square feet or more, or with 15 or more parking spaces, and potentially exposed to urban
runoff -
10. Retail Gasoline Outlets -serving_ more than 100 vehicles g_er day X Serving more than 100 vehicles per day and greater than 5,000 square feet
11. Streets, roads, driveways, highways, and freeways. t>< Project would create a new paved surface that is 5,000 square feet or greater.
12. Coastal Development Zone. IX Within 200 feet of the Pacific Ocean and (1) creates more than 2500 square feet of impermeable
surface or (2) increases impermeable surface on property by more than 10%.
1 Environmentally Sensitive Areas include but are not limited to all Clean-Water Act Section 303(d) impaired water bodies;
areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality
Control Plan for the San Diego Basin (1994) and amendments); water b0dies designated with the RARE beneficial use by
the State Water Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments);
areas designated as preserves or their equivalent under the Multi Species Conservation Program within the Cities and Count
of San Diego; and any other equivalent environmentally sensitive areas which have been identified by the Copermittees.
2 "Directly adjacent'' means situated within 200 feet of the environmentally sensitive area.
3 "Discharging directly to" means outflow from a drainage conveyance system that is composed entirely of flows from the
subject development or redevelopment site, and not coryimingled with flow from adjacent lands.
Section 1 Results:
If you answered YES to ANY of the questions above you have a PRIORITY project and PRIORITY project requirements DO
apply. A Storm Water Management Plan, prepared in accordance with City Storm Water Standards, must be submitted at
time of application. Please check the "MEETS PRIORITY REQUIREMENTS" box in Section 3.
If you answered NO to ALL of the questions above, then you are a NON-PRIORITY project and STANDARD requirements
apply. Please check the "DOES NOT MEET PRIORITY Requirements" box in Section 3.
SWJvlP Rev 6/4/08
,(
j SECTION 2
SIGNIFICANT REDEVELOPMENT: YES NO
1. Is the project redeveloping an existing priority project type? (Priority projects X are defined in Section 1)
If you answered YES, please proceed to question 2.
If you answered NO, then you ARE NOT a significant redevelopment and you ARE NOT subject to
PRIORITY project requirements, only STANDARD requirements. Please check the "DOES NOT MEET
PRIORITY Requirements" box in Section 3 below.
2. Is the project solely limited to one of the following: '
a. Trenching and resurfacing associated with utility work?
b. Resurfacing and reconfiguring existing surface parking lots?
C. New sidewalk construction, pedestrian ramps, or bike lane on public
and/or private existing roads?
d. Reolacement of existing damaged pavement?
If you answered NO to ALL of the questions, then proceed to Question 3.
If you answered YES to ONE OR MORE of the questions then you ARE NOT a significant redevelopment
and you ARE NOT subject to PRIORITY project requirements, only STANDARD requirements. Please
check
the "DOES NOT MEET PRIORITY Requirements" box in Section 3 below.
3. Will .the development create, replace, or add at least 5,000 square feet of
X impervious surfaces on an existing development or, be located within 200
feet of the Pacific Ocean and (1)create more than 2500 square feet of
impermeable surface or (2) increases impermeable surface on property by
more than 10%?
If you answered YES, you ARE a significant redevelopment, and you ARE subject to PRIORITY project
requirements. Please check the "MEETS PRIORITY REQUIREMENTS" box in Section 3 below.
If you answered NO, you ARE NOT a significant redevelopment, and you ARE NOT subject to
PRIORITY project requirements, only STANDARD requirements. Please check the "DOES NOT MEET
PRIORITY Requirements" box in Section 3 below.
I SECTION 3
Questionnaire Results:
□ MY PROJECT MEETS PRIORITY REQUIREMENTS, MUST COMPLY WITH PRIORITY
PROJECT STANDARDS AND MUST PREPARE A STORM WATER MANAGEMENT PLAN FOR
SUBMITTAL AT TIME OF APPLICATION.
MY PROJECT DOES NOT MEET PRIORITY REQUIREMENTS AND MUST ONLY COMPLY
WITH STANDARD STORM WATER REQUIREMENTS.
Applicant Information and Signature Box This Box for City Use Only
Assessors Parcel Number(s):
'Z..\'3,-\QO -OZ. City Concurrence: I YES I
I I
Applicant Title:
~S~1r-
By:
Date:
Date: Project ID:
t~ 2..\ ()~
NO
SW:MP Rev 6/4/08
PLEASE NOTE:
• Time limits on the processing of discretionary projects established by state law do not start until
a project application is deemed complete by the City. The City has 30 calend~u days from the
date of application submittal to determine whether an application is complete or incomplete.
Within 30 days of submittal of this application you will receive a letter stating whether this
application is complete or incomplete. If it is incomplete, the letter will state what is needed to
make this application complete. When the application is complete, the processing period will
start upon the date of I~ l~tter. 1 ---z..___,, \..
Applicant Signature: • \ -., r--
Staff Signature: ~ A l ~ v}tt}:N.._
Date:
• To be stapled with receipt to the application
• Copy for file
Form 20
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